The impact of mothers and daughters health education on female adolescents' quality of life during the COVID-19 pandemic.

PROBLEM: Adolescence is a period of biological, cognitive, psychosocial, and emotional development. Negative experiences of Coronavirus (COVID-19) infection are associated with more changes which impacts on quality of life (QoL). However, parent-proxy and child self-reports may vary, and we have lack of knowledge about these discrepancies. The aim of this study was to identifying the impact of mother-daughter health education on female adolescents' QoL during the COVID-19 pandemic. METHODS: This quasi-experimental study was conducted at two time points; before (T1) and 3 months after health education thorough blended learning (T2) from January to May of 2020. Then 196 participants were divided into intervention (N = 96) and control (N = 100) groups and Health Related QoL was assessed using the PedsQL™. RESULTS: The results showed significant increase in scores of total QoL and all QoL domains in adolescents by self-reports of adolescents and mothers proxy reports (except emotional performance) compared to the control group at T2 (p < 0.05). Furthermore, mother's rated increase in social performance significantly higher in both groups at T2. CONCLUSIONS: With high social anxiety due to COVID-19, adolescents may be vulnerable to various risks. Improving mothers understanding of the needs of their adolescents are an important issue; given that it is possible increase their QoL by health education, especially during COVID-19 pandemic. It is recommended to organized health education in schools to increase the knowledge of mother-daughter thorough blended learning.

Association between burnout and nurses' quality of life in neonatal intensive care units: During the COVID-19 pandemic.

Background: Neonatal intensive care unit (NICUs) nurses could suffer from job stress and burnout, which could cause increased turnover rates and decreased Quality of Life (QoL) among nurses. Purpose: To determine the association between burnout and nurses' QoL in NICUs. Study design: This correlational study was performed in 2020 on 140 nurses working in NICUs. The Maslach burnout and WHO Quality of Life-BREF was used to collect data. Results: There is a positive association between personal accomplishment and all dimensions of QoL (r = 0.40 to 0.56) and a negative association between emotional exhaustion, depersonalization of burnout and all dimensions of QoL (r = -0.47 to -0.79). Conclusion: It is suggested that several interventions must be taken to prevent burnout and increased QoL in NICU nurses. The findings could provide scientific evidence for managers and encourage evidence-based decision-making to reduce burnout and improve the QoL of nurses especially during the Covid-19 pandemic.

Psychometric evaluation of the Persian version of the Heart Disease Fact Questionnaire (HDFQ) in people with diabetes in Iran.

BACKGROUND AND AIMS: Public health and clinic-based educational strategies are desperately needed to stem the tide of death from heart disease among people with diabetes in low and middle-income countries. This study translated the Heart Disease Fact Questionnaire into Persian and evaluated its reliability and validity for use in Iran. METHODS: Using rigorous translation methods, the 25-item scale was administered to Persian speakers with diabetes. The scale was evaluated for content validity, construct validity and reliability. RESULTS: Participants were 268 patients with diabetes with mean age of 63.19 ± 16.61 years. The mean HDFQ score was 17.31 ± 5.11 (in the low range). Higher scores were associated with younger age, younger age of diabetes onset, higher education, higher employment position, family history of diabetes and hypertension, shorter diabetes duration, and adherence to home exercise regimens. Kuder-Richardson's reliability coefficient was good, i.e., 0.82. Confirmatory factor analysis showed that the factor loadings of all questions, except question number 25, were favorable, i.e., >0.3. Model fit indices were favorable: Chi-square statistic to degree of freedom ratio (χ2/df) = 1.82, Comparative fit index = 0.96, Tucker-Lewis Index = 0.96 and root mean square error = 0.06. CONCLUSION: After removing item #25, the Persian heart disease fact questionnaire has good validity and reliability and can be used to inform and evaluate clinical and public health educational programs aimed at decreasing risk for heart disease among Persian speakers with diabetes.

Effect of video games on preoperative anxiety in 3- to-6-year-old of a sample of Iranian children undergoing elective surgery.

BACKGROUND: As pediatric surgeries are rising and current methods to reduce perioperative anxiety are lacking in preschool children. The purpose of this study was to determine the effect of video games on preoperative anxiety in 3- to-6-year old of a sample of Iranian children undergoing elective surgery children. MATERIALS AND METHODS: In the current quasi-experimental pretest posttest design, after standard translation, the modified Yale preoperative anxiety scale was administered to 102 children undergoing surgery from December 2016 to August 2017 in Kermanshah, Iran. Children are assigned to an intervention or control group. Each child's anxiety was measured at two points at the time of arrival and after waiting for 20 min in the holding area. Data were analyzed by SPSS, version 22. The Chi-square, independent t-test, and paired t-test at the significance level of P < 0.05 were performed. RESULTS: There was no significant difference between the mean anxieties in control group (42.58 ± 18.54) and intervention group (46.11 ± 14.09) before the game (P = 0.282). However, after playing the video game in control groups (53.26 ± 18.00) and game groups (34.88 ± 10.81), there was a significant difference in favor of the video game (P < 0.001). CONCLUSION: Findings of the present study suggest that approved video game by experts to decrease mean preoperative anxiety in 3- to-6-year-old children. Therefore, video games recommended to be implemented at the preventive level in hospital.

Translational cultural adaptation and psychometric study of the Persian version of pediatric inventory for parents.

BACKGROUND: Cancer, as a life-threatening disease in children, poses several challenges for parents. It is necessary to have a tool that can comprehensively examine the stressful events for parents of children with cancer. The aim this present study was done with the aim of study the Persian version of pediatric inventory for parents (PIP). MATERIALS AND METHODS: The study was a conducted based on methodological research design. Four hundred and fifteen parents of children with cancer referring to Alia Asghar Children's Hospital and Children's Medical Centre in Tehran answered the Persian version of PIP questionnaire in 2019. a confirmatory factor analysis was carried out using LISREL (software version 8.8) to test the construct validity of PIP. The two tools of parental stress scale and state-trait anxiety inventory (STAI-Y) were used for concurrent validity purposes. RESULTS: The results showed that, the overall score of the questionnaire was higher than the average and related to emotional distress. The internal correlation coefficient (Cronbach's alpha) in both parts of the PIP was between 0.808 and 0.957 and acceptable. Concurrent validity analysis indicated positive and significant correlation of this tool in the difficulty section of the scale with both Parental Stress Scale and STAI-Y. The results of confirmatory factor analysis indicated that the factor loads of all items except three items in the frequency section were more than 0.3 and were appropriate. CONCLUSION: The Persian version of PIP can be available to health and family experts as a valid and reliable tool to assess stressful events of parents of children with cancer.

Healthcare professionals-related factors affecting parents' participation in decision making for neonates with life-threatening conditions: A qualitative study.

RATIONALE, AIMS, AND OBJECTIVES: Neonates with life-threatening conditions face complex clinical circumstances that confront parents and professionals with ethical decisions. Parents' participation in decision making has not gained sufficient attention in practice. Understanding factors affecting parents' participation is required. This study is part of a comprehensive project that explored the process of parents' participation in decision making for neonates with life-threatening conditions. The current study aimed to explore healthcare professionals-related factors affecting parents' participation in decision-making for neonates with life-threatening conditions. METHODS: A grounded theory methodology was used in the comprehensive project. Twenty-two interviews/68 hours of observation were conducted. Data were concurrently analysed throughout data generation and constant comparative analysis. Data collected until theoretical saturation was reached, the extracted categories were coherent and the emerging theory made sense. After coding stages, the core category and the relationships with other main categories involved in the process of parents' participation in decision-making were developed. For this study, the category reflecting healthcare professionals-related factors affecting parents' participation in decision-making was reported. RESULTS: Four themes were found: risk aversion including fear of litigation, fear of being accountable to the parents, and fear of bearing emotional distress; unprofessionalism including poor adherence to professional ethics, inadequate skill/knowledge, poor communication, and nurses' negligence in playing their professional role; information deficiencies including insufficient information, conflicting information, and complex and technical information, and clashes of attitudes including conflict about parents' participation in decision-making and conflict about the best interest of neonates. CONCLUSION: Professionals should be aware of their role in involving parents in decision making. Training professionals on family centred care principle and communication skills contribute to support parents emotionally and respond empathically to their negative expressions. Training on ethics, development, and dissemination of guidelines and rules of conduct can make professionals more sensitive to ethical aspects of their work and may reduce their fear of litigation.

Impact of Coping Skills Training on the Quality of Life Among the Daughters of Mothers with Breast Cancer.

BACKGROUND: Cancer affects the quality of life (QoL) of patients and their families. The purpose of this study was to determine the effect of coping skills training on the QoL among daughters of mothers with breast cancer. METHODS: In this quasi-experimental pre-test/post-test design, data were collected from 70 participants (35 in each of the control and education groups) from January 2016 to July 2017 in Imam Khomeini and Rasole-e-Akram Hospitals in Tehran. The education group participated in a workshop and group discussion (groups of 5 to 8 participants) with the presence of a pediatric psychiatrist and two pediatric nurses, and then a follow up program was performed. The Pediatric Quality of Life Inventory version 4.0 was used in this study in two stages of pre-test (before education) and post-test (four weeks later). Data were analyzed through SPSS, version 21 using independent t-test and paired t-test for comparison of the mean scores of the two groups, with the significance level of 0.05. RESULTS: After the education, there were significantly improved scores of the QoL in the dimensions of physical functioning (P<0.001), emotional functioning (P<0.001), and school functioning (P<0.001) in the study group compared to the control group. The social functioning did not show a significant change (P<0.083). CONCLUSION: The findings of the study confirm that coping skills training can lead to the improvement of QoL in adolescent daughters of mothers with breast cancer. Healthcare professionals must provide the mothers and daughters with information about breast cancer and instruments to handle their situation to promote the daughters' QoL.

Impact of an Educational Program on Nurses' Performance in Providing Peripherally Inserted Central Catheter Care for Neonates.

All nurses who care for neonates with peripherally inserted central catheters require enhanced awareness of the current practice guidelines and standards. This study evaluated the impact of an educational program on nurses' performance from May 2016 to July 2017 at 4 hospitals in Tehran, Iran. The performance of 80 nurses was observed and scored 3 times before the intervention. Four weeks after the last training session, their performance was observed with the same researcher, and the checklist was completed 3 times in different working shifts. Four 35- to 45-minute training sessions were completed with a 4-week follow-up. Results of the study indicated that training courses should be held every 6 months, including permanent or periodic feedback.

The need for renovating patient education in kidney transplantation: A qualitative study.

BACKGROUND: Many kidney transplant recipients lack the knowledge, abilities, and support they need for self-care. On the other hand, most kidney transplant centers do not have a well-planned and specific training program for them, and educational interventions for kidney transplant recipients have not been adequately effective. This study aimed to describe strategies for improving patient education in kidney transplantation. MATERIALS AND METHODS: Data were collected through semi-structured individual and group interviews with 24 patients, family members, and health-care staff in one of the main kidney transplant centers in Tehran. Participants were selected purposefully, and qualitative content analysis was used to analyze the data. RESULTS: The main finding emerged from the data was the shift from current patient education program to patient- and family-centered education (PFCE). The strategies to achieve this goal were categorized into four main categories including "continuous patient and family education" (pre- and posttransplant patient education), "facilitating the process" (using new technologies, teamwork education, and patient and family accessibility), "strengthening human resources" (empowerment health-care team, allocation of human resources, promoting staffs' motivation, and updating educational content and materials), and "monitoring and evaluation" (correcting patient education recording, supervising the patient education, and appropriate educational evaluation). CONCLUSIONS: Transforming from the current patient education program to PFCE seems to be essential to increase the effectiveness of patient education in kidney transplant process. To this end, providing continuous patient and family education, facilitating the processes, strengthening human resources, and monitoring and evaluation in health-care organizations conducting the kidney transplantation is necessary.

Effect of the combination of Benson's relaxation technique and brief psychoeducational intervention on religious coping, sense of coherence, and quality of life of family caregivers.

INTRODUCTION: Chronic diseases leave a huge impact on the life of children and their family caregivers (FCGs). Therefore, the present study was conducted to determine the effect of the combination of Benson's relaxation technique (BRT) and brief psycho-educational intervention (BPI) on religious coping (RCOPE), sense of coherence (SOC), and quality of life (QoL) of FCGs in children with chronic disease. MATERIALS AND METHODS: The study population, consisted of 100 FCGs whose children were afflicted by chronic diseases, and participated in the current quasi-experimental pretest posttest design. The children were recruited from two state pediatric hospitals in Tehran, Iran. The RCOPE, SOC, and QoL of FCGs were assessed twice, through pretest (T1) and posttest (T2), four weeks after the intervention, by means of RCOPE, SOC and SF-36 questionnaires. The FCGs participated in four training sessions lasting up to 70 min over one week, followed by four more weeks of training. The Chi-square, Fisher's exact tests, independent t-test, and paired t-test were performed. RESULTS: Positive RCOPE had a significant rise at T2 (P = 0.020) compared with negative RCOPE that did not show significant changes in T2. SOC scores for the intervention group remarkably rose at T2 (P = 0.022); but, for the control group, the drop was marginal. The QoL scores of both physical and mental components were statistically significant in the intervention group at T2 (P < 0.05). CONCLUSION: Findings of the present study suggest that BRT and BPI can help significantly improve the RCOPE, SOC, and QoL of families with children suffering from chronic diseases. Measures that could enhance the RCOPE, SOC, and QoL include low-cost interventions, good safety, and decent outcome.

The effect of family-centered education on the quality of life of adolescents with spinal cord injuries.

BACKGROUND AND PURPOSE: Spinal injury is a destructive complication creating huge changes in the teen health and lifestyle, depending on its extent and severity. Although most of the complications of this disease are treatable, they impose huge costs on the healthcare system, the patient, and his family. The present study was conducted to investigate the effect of family-centered education on the quality of life and self-esteem of adolescents with spinal cord injuries. METHOD: The present study is a quasi-experimental study. Adolescents (108 old) with spinal cord injuries entered the present study through stratified sampling with appropriate allocation. The participants were compared in two groups of experimental and control. The data was collected using demographic information questionnaire as well as Ferrans and Powers' quality of life index in spinal cord injury. Four weeks after the intervention, the research questionnaires were completed once more by the adolescents of both groups. Data analysis was conducted by using T-square test, independent t-test, Fisher's exact test, and analysis of variance. FINDING: According to results, quality of life mean score of adolescents with spinal cord injuries was 23.05 ± 122.65 before the intervention. It became 22.64 ± 148.15 after the intervention. With respect to importance, quality of life mean score of these adolescents changed from 20.83 ± 164.07 to 21.62 ± 174.99. CONCLUSION: Given the effect of family-centered education on the quality of life in adolescents with spinal cord injuries, it seems essential to create necessary grounds for training families having adolescents with spinal cord injuries by nurses to improve their quality of life as well as conducting researches on their problems.

Impact of an education program on the performance of nurses in providing oral care for mechanically ventilated children.

BACKGROUND: Mechanically ventilated children are prone to pneumonia due to immobilization and lack of laryngeal (cough) reflex and swallowing. Nurses are directly responsible for many clinical approaches used to prevent ventilator-associated pneumonia. OBJECTIVE: The research objective is to determine the effectiveness of the nurse education program on the performance of nurses in providing oral care for mechanically ventilated children. METHODS: This quasi-experimental pretest-posttest design was conducted on 100 nurses (50 in each of the control and intervention groups) in pediatric intensive care units (PICU) in Tehran, 2015. The research tools included a demographic form and three checklists for evaluation of performance according to the clinical practice guidelines for the oral health status of children in PICU. Before intervention, the performance of nurses in both groups was observed at three stages and three different shifts, using an observational checklist. After one month, their performance was observed again with the same checklist at three stages and three different shifts in the PICU. The training was done in four 40-50 minute sessions in a workshop with a 4-week follow-up. The Chi-square test, Fisher's exact test, paired t-test, independent t-test, and regression analysis comprised the tools used to analyze the data. FINDINGS: The mean performance scores of nurses before the education program in the intervention and control groups were 42.8 (±18.5) and 48.7 (±15.7), respectively. These scores improved to 68.6 (±31.4) and 48.6 (±15.4) four weeks after the intervention (p < 0.001). CONCLUSION: The performance of nurses in providing oral care for mechanically ventilated children improved after the intervention. It is recommended to implement this program for all nurses, regardless of their ward or specialty, based on the clinical practice guidelines. The periodic refreshing in-service training program should be provided to nurses in PICU in order to enhance their performance in providing oral care.

Investigating the relationship between the quality of life and religious coping in mothers of children with recurrence leukemia.

BACKGROUND: Leukemia is a life-threatening chronic disease for children. The recurrence of the disease causes tension and reduces the quality of life for the family, especially for mothers. Religion is an important humanitarian aspect of holistic care that can be very effective in determining the health level of the patient and the family members. The present study aims at investigating the role of religious coping (RCOPE) in the quality of life for mothers of children with recurrent leukemia. METHODS: This is a cross-sectional study of the descriptive-correlational type. Two-hundred mothers with children aging 1-15 years suffering from leukemia were selected using a continuous sampling method. The data were collected using questionnaires eliciting information about personal information, Persian version of the Caregiver Quality of Life Index-Cancer, and RCOPE. The collected data were analyzed in SPSS using descriptive tests and independent samples t-test. RESULTS: The result of examining the relation between life quality and demographic features of mothers showed that education level, income, and occupation had a significant statistical relationship with general quality of life mothers. The results of examining the relationship between quality of life and RCOPE of mothers showed that RCOPE was positively correlated only with the positive coping dimension quality of life (P < 0/001). Negative RCOPE had a significant reverse statistical correlation with general quality of life and all its aspects. CONCLUSION: The quality of life for the participants in this study was significantly related to RCOPE. Mothers with negative RCOPE faced low scores for quality of life, and religious support can improve their life quality. Further longitudinal studies are required to investigate the effects of establishing support communities.

Contribution of Benson's Relaxation Technique and Brief Psycho-Educational Intervention on Quality of Life of Primary Caregivers of Iranian Children with Chronic Diseases.

BACKGROUND: Chronic diseases leave a significant effect on not only the afflicted children but also their parents. Chronic diseases in children may also influence their parents' or primary caregivers' quality of life (QoL). OBJECTIVE: To determine the effectiveness of a Brief Psycho-educational Intervention (BPI) and Benson's Relaxation Technique (BRT) on the QoL of primary caregivers of children with chronic diseases. METHODS: The present quasi-experimental pre-test post-test design was conducted on 100 parents with children who had one chronic disease (50 in each of the control and intervention groups) and were admitted to two state-run pediatric hospitals in Tehran, Iran in 2014. The primary caregivers' QoL was assessed using the SF-36 questionnaire before (T1) and four weeks after the intervention (T2). The training was done in four 60-70minute sessions over one week with a 4-week follow-up. Paired t-test, independent t-test, chi-square and Fisher's exact tests were used to analyze the data. RESULTS: On average, large effect sizes (ES≥0.80) were observed after interventions in SF-36 subscales that measured the effect of emotional roles. Small (0.20-0.49) to moderate (0.50-0.79) ESs were found in subscales measuring physical functioning, physical-role, bodily pain, vitality, social functioning and mental health. General health scores remained relatively unchanged at T2. CONCLUSION: These results suggested that BPI and BRT were effective strategies to improve the QoL of primary caregivers. Furthermore, interventions with low cost, and good safety and outcome could improve the QoL of primary caregivers of children with chronic diseases.

Family caregivers of women with breast cancer in Iran report high psychological impact six months after diagnosis.

PURPOSE: To explore how family caregivers of women with breast cancer in Iran describe the areas in life which are important to their quality of life (QoL), and to determine which areas in life that are influenced by having a family member with breast cancer. METHODS: The study is descriptive and prospective. A total of 88 family caregivers of women newly diagnosed with breast cancer were interviewed using the Schedule for the Evaluation of Individual Quality of Life (SEIQoL-DW) at a time close to diagnosis and then again at 6 months after. Interviews were analyzed by manifest inductive qualitative content analysis. RESULTS: Areas related to the categories Own and Family health, and Relationships were considered to be the most important to QoL. A majority of the family caregivers reported that concerns categorised as Psychological impact had high influence on QoL shortly after diagnosis and the following six months. Other areas that were frequently mentioned at both time points were categorized as Focus on family health, Concerns about the disease, and Change in family relationship. Positive aspects in life were also reported as a consequence to the breast cancer diagnosis. CONCLUSIONS: High psychological impact is a concern of family caregivers six months after diagnosis of breast cancer. It is imperative that family caregivers are given early attention, and the opportunity to express their perceptions and needs, as this may lead to a better understanding of their experience, thus providing guidance for supportive interventions.

Psychometric testing of the Caregiver Quality of Life Index-Cancer scale in an Iranian sample of family caregivers to newly diagnosed breast cancer women.

AIM: To translate and test the reliability and validity of the Persian version of the Caregiver Quality of Life Index-Cancer scale. BACKGROUND: Research across many countries has determined quality of life of cancer patients, but few attempts have been made to measure the quality of life of family caregivers of patients with breast cancer. The Caregiver Quality of Life Index-Cancer scale was developed for this purpose, but until now, it has not been translated into or tested in the Persian language. DESIGN: Methodological research design. METHODS: After standard translation, the 35-item Caregiver Quality of Life Index-Cancer scale was administered to 166 Iranian family caregivers of patients with breast cancer. A confirmatory factor analysis was carried out using LISREL to test the scale's construct validity. Further, the internal consistency and convergent validity of the instrument were tested. For convergent validity, four instruments were used in the study: sense of coherence scale, spirituality perspective scale, health index and brief religious coping scale. RESULTS: The confirmatory factor analysis resulted in the same four-factor structure as the original, though, with somewhat different item loadings. The Persian version of the Caregiver Quality of Life Index-Cancer scales had satisfactory internal consistency (0·72-0·90). Tests of convergent validity showed that all hypotheses were confirmed. A hierarchical multiple regression analysis additionally confirmed the convergent validity between the total Caregiver Quality of Life Index-Cancer score and sense of coherence (ß = 0·34), negative religious coping (ß = -0·21), education (ß = 0·24) and the more severe stage of breast cancer (ß = 0·23), in total explaining 41% of the variance. CONCLUSION: The Persian version of the Caregiver Quality of Life Index-Cancer scale could be a reliable and valid measure in Iranian family caregivers of patients with breast cancer. RELEVANCE TO CLINICAL PRACTICE: The Persian version of the Caregiver Quality of Life Index-Cancer scale is simple to administer and will help nurses to identify the nursing needs of family caregivers.

Lower sense of coherence, negative religious coping, and disease severity as indicators of a decrease in quality of life in Iranian family caregivers of relatives with breast cancer during the first 6 months after diagnosis.

BACKGROUND: Breast cancer challenges not only the patients who suffer from the disease but also their family caregivers. Little is known about how Iranian family caregivers are influenced. OBJECTIVE: The objective of the study was to describe quality of life (QoL), well-being, sense of coherence (SOC), spirituality, and religious coping in family caregivers of patients with breast cancer at the time of diagnosis (T1) and 6 months after diagnosis (T2) and identify predictive factors of change in QoL. METHODS: Data were collected from 150 family caregivers. The Persian version of Caregiver Quality of Life Index-Cancer, Sense of Coherence Scale, Spirituality Perspective Scale, Religious Coping Scale, and the Health Index were used at T1 and T2. RESULTS: The results showed significant increase in overall QoL (P = .00) and well-being (P = .03) at T2. However, ratings of their SOC (P = .03), spirituality (P = .01), and negative religious coping (P = .00) decreased. Multiple regression analyses revealed the rating of QoL at T1 as the strongest predictor in the rating of quality-of-life change at T2 followed by the degree of SOC, negative religious coping, and patients having more severe breast cancer (R² = 0.64). CONCLUSION: Despite improved QoL in the sample from diagnosis to 6 months, family caregivers struggle to cope with the situation. IMPLICATIONS FOR PRACTICE: It is suggested to develop and investigate the effects of support programs targeting coping ability in Iranian family caregivers to women with breast cancer.

Health index, sense of coherence scale, brief religious coping scale and spiritual perspective scale: psychometric properties.

AIM: This paper is a report of a study to translate one Swedish and three English instruments into the Persian language, and to estimate their validity and reliability. BACKGROUND: The Sense of Coherence Scale, Health Index, Brief Religious Coping Scale and Spiritual Perspective Scale are all well tested instruments for use in nursing research. Since there was no Persian translation of these instruments, they had to be translated and cross-culturally adapted for nursing research in the Iranian culture. METHOD: After the translation process, sampling for psychometric tests was done. A sample of healthy Iranian people (n = 375) was selected to response to the instruments in 2006, at baseline and 1 month later. FINDINGS: Cronbach's alpha values and intra-class correlations were high (>0·70). Tests of criterion-related validity showed that six of the ten hypotheses were confirmed, and the four rejected hypotheses did not imply a threat to validity. Hierarchical multiple regression analysis showed that sense of coherence was the strongest predictor of well-being (Health Index scores) both at baseline (= 0·52, P < 0·001) and 1 month later (= 0·58, P < 0·001). CONCLUSION: There is a sound psychometric basis for using the Iranian versions of these instruments in nursing research with the Iranian population. The Sense of Coherence Scale proved to be as valid and reliable as in Western countries, which supports its cross-cultural applicability.